Wednesday, June 9, 2010

Infertility Counseling: Getting the most out of therapy

If you never have been in therapy before, or if you are beginning a relationship with a new therapist, or if earlier counseling experiences have had nothing to do with your infertility, you probably are feeling perched on the brink of a new opportunity and a new challenge. Undoubtedly you already are receiving either a diagnostic workup or medical treatment for your infertility, and your decision to seek counseling is an important step in handling the many emotions that emerge in this process. So, now that you and your counselor are beginning your relationship, how can you get the most out of the therapeutic experience?

Most therapists will initially ask you to be clear about what you hope to gain from therapy. I'm going to make the assumption that you and your partner are going to the first session together, so both of you will need to think about how you would answer this question. It is not unusual for partners to have different perspectives on the challenges posed by infertility (see my video at ), so you both should feel free to speak for yourselves. Also, if some issues are more compelling than others, or if you have tried and not succeeded to make desired changes in your lives, it is good to provide that information as well.

In addition to answering questions posed by your counselor (who, for the sake of pronoun simplicity, I will assume is female), you should feel free to ask her to talk about how she sees her role as a therapist, what expectations she will have of you as clients, how she guides the counseling process with her clients, and how you and she will know whether you have accomplished as much as possible in your relationship with her. You should be listening for how open she is to your input, how she formulates goals for the counseling experience, how familiar she is with infertility, particularly issues of loss and communication difficulties, and how she evaluates whether she is being helpful in moving you toward the changes you hope to accomplish.

For you and your partner, both of you should be prepared to view therapy as work: on your relationship, on your relationships with others in your lives, on your communication skills, on your willingness to strive for insight, and on your openness to considering new options in making decisions about your future. As I have mentioned in an earlier blog, I tend to give homework assignments, and if your therapist follows this practice, it is helpful to be conscientious about the therapeutic learning that takes place both outside and inside the therapist's office. You might think of it as having ongoing practice with new skills or discussing new perspectives, which you then can review with your therapist in your regular appointments.

From this perspective, you can see that I tend to favor a therapeutic perspective that helps you to feel empowered, both in new skills you acquire and in new ways of considering how you will handle the stress and the decisions imposed by your infertility experience. This is not the only therapeutic perspective, and it may not be the most productive one for every client. So the important thing for you and your partner is to assess how you feel about your therapist's way of viewing her relationship with you, her willingness to accept your input and your questions, and her willingness to challenge you to think in new ways about painful issues. Therapy is not a full-time "feel good" experience, but it should be a relationship in which you feel both trust and confidence that your counselor has her finger on your emotional pulse and is keeping pace with your readiness to move forward.

With your infertility physician, there should be times when you pause to assess where you are and what's next. The same is true in therapy. I use every 6-8 weeks as my "pausing point" with clients, partly to check out how they are feeling about the changes we are working on, partly to give them my feedback on their new skills and the work that lies ahead, and certainly to see whether they are satisfied with the direction and the pace at which I'm encouraging them to move. I always welcome critical feedback or discussion of therapeutic frustrations at any point during therapy, but I also am a big believer that a regular pausing point helps my clients and me to be attentive to both progress and pace.

Let me spend some time now on ending the counseling relationship. Ideally this decision is a mutual one, perhaps growing out of a conversaton at one of your pausing points. In the best of circumstances it will be an outgrowth of achieving the goals you set in the course of therapy or, even more hopefully, your success in becoming pregnant (although I confess that most of my client couples have found pregnancy to have its own stresses, so many of my clients continue on a reduced schedule until they have celebrated a healthy birth). In less favorable circumstances you may find that you are dissatisfied with your therapist, efforts to address those dissatisfactions have not yielded changes, and you decide to end the relationship. Then the question becomes whether you believe that it would be constructive to identify a new therapist, in which case you hopefully will have a more successful experience. But if you are ending therapy on a successful note, feel free to raise with your therapist that, if new concerns arise, or if you find yourself needing a "booster" session, you hope that you and she could reconnect to assess next steps.

So, in the spirit of "getting the most out of therapy," I hope my perspective is helpful in your anticipating how you might begin your therapeutic relationship, as well as how to provide input as the relationship progresses.
Infertility is not a smooth road to travel, but the support and skills of a good therapist can help you feel empowered as you face emotional challenges.

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